Provider Demographics
NPI:1861091209
Name:MASSIE, HEATHER INELIA
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:INELIA
Last Name:MASSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 CEDAR CANYON DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-9005
Mailing Address - Country:US
Mailing Address - Phone:405-328-4382
Mailing Address - Fax:
Practice Address - Street 1:1117 CEDAR CANYON DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-9005
Practice Address - Country:US
Practice Address - Phone:405-328-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant